Intubation in Cardiac Arrest - Spin Off From Pain Mgmt EMTB

[Asysin2leads]

Heh, I got general surgery or pulmonology. General surgery is a little above my pay grade but pulmonology I could do. After all, I like to vent! Get it... ah nevermind.

[Kiwiology]

Ah fahgetabudit lets go get a pepperoni pizza

[croaker260]

I agree that science is a good thing, but I have been around long enough to see multiple changes in ACLS and AHA recommendations throughout the years, BASED ON THE LATEST SCIENTIFIC STUDIES, and guess what --- there has still not been any substantial change in survival rates.

Actually, there have been some area's that have indeed seen an increase in ROSC of up to 20% and increase at 30 days as well. Hell, a few years ago KCM1 even broke the 50% mark for VF ROSC. That hasnt been done since the 50's with the original MICU study out of Ireland.

The places that dont show improvement either (a) arnt taking CPR/ROSC seriously on a system wide level, or ( have factors they havent overcome yet (like response times in rural settings.)

GRANTED, these improvements are MULTI-FACTORIAL, but there is no doubt that the re-emphasis on CPR/CCR is part of the solution. Hypothermia, public awareness, and other factors also play a part.

[mikeymedic1984]

I am not against trying to find things that work better, just saying before you adopt the latest greatest scientific change as fact, realize that it rarely meets the hype (think of all the money wasted on Amiodarone, when we could have just kept using Lidocaine and used the savings to buy more AEDs or hold more community CPR classes).

[BushyFromOz]

I am not against trying to find things that work better, just saying before you adopt the latest greatest scientific change as fact, realize that it rarely meets the hype (think of all the money wasted on Amiodarone, when we could have just kept using Lidocaine and used the savings to buy more AEDs or hold more community CPR classes).

those recommendations from ILCOR were adopted here, and melbourned has ROSC rates over 50% with survival to discharge approaching 30%. Country victoria has survival to discharge approaching 20%

[vaflightmedic]

Like has been stated above, the kicker isn't necessarily the placement of the advanced airway, it's the interruption in CPR and hyperventilation that are the problem. The question doesn't fall on the equipment IMO, but it falls on the efficiency of the provider.

[Bieber]

I agree that science is a good thing, but I have been around long enough to see multiple changes in ACLS and AHA recommendations throughout the years, BASED ON THE LATEST SCIENTIFIC STUDIES, and guess what --- there has still not been any substantial change in survival rates. So yes, you can find a study by now that says intubation is bad, but in 8 years we will be putting it back in. I will boldly predict now that the next ACLS changes will bring back pushing 2 amps of bicarb and a D50 in every code (lol, along with some D5W TKO says gage).

For your viewing pleasure!

http://circ.ahajourn...064873.abstract

Conclusions—Outcomes from OHCA due to non-shockable rhythms, though poor by comparison with shockable rhythm presentations, improved significantly after implementing resuscitation guideline changes, suggesting their potential to benefit all presentations of OHCA.

While the science does in fact change constantly, that's part of the beauty and greatness of medicine--we're dynamic. It's not a sign of weakness in previous studies if something new comes out that refutes a previous change, but a strength of our deductive skills to learn from what we thought we knew and to adapt our practice. Ultimately, the science of resuscitation is probably going to be an amalgamation of a multitude of different practices which individually or in a certain combination with other treatments may not produce great results, but which, when worked together in just the right way, gives us the very best chance for positive outcomes with our patients.

I also agree that we should not do things just because we always have, but in this case, "intubation" (when done right) has served patients well for many decades, so I am not willing to just throw it out the window.

But if there are studies which say that patients aren't, in fact, served well by intubation, can we really say that it is effective? I'm not arguing that there isn't a place for intubation in EMS, I just don't think that, typically, it is what we need to be focused on while treating patients of cardiac arrest. In the post-arrest period, sure, there may be a role for it, as well as in other conditions, but the only two things that have been definitely proven to make a difference in cardiac arrest are CPR and defibrillation.

Like has been stated above, the kicker isn't necessarily the placement of the advanced airway, it's the interruption in CPR and hyperventilation that are the problem. The question doesn't fall on the equipment IMO, but it falls on the efficiency of the provider.

This. But the question remains, when there's so much risk to interrupting CPR to place a tube and so little evidence suggesting it provides any benefit in patients who are in active arrest, should we even be attempting to get one in? Even if we're confident that we can do so without interrupting CPR?

Addendum: Also, insert something here about the associated problems regarding high flow oxygen and ischemic tissue.

Edited May 1, 2012 by Bieber